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Jaihwan Kim
Seoul National University Bundang Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0693-1415
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Background:The combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is a very effectivechemotherapeutic regimen forunresectable pancreatic cancer.Previous studies have reported that female sex may be a predictor of a better response to FOLFIRINOX. This study was aimed at investigating the clinical outcomes and dose modification patterns of FOLFIRINOX by sex.
Methods:Patients with metastatic pancreatic cancer(MPC) who began FOLFIRINOX as the first-line therapy at Seoul National University Bundang Hospital between 2013 and 2018 were enrolled. The patients received at least four chemotherapy cycles. Local regression and a linear mixed model were used to analyze dose modification patterns by sex.
Results:Ninety-seven patients with MPC (54 men;43 women) were enrolled. In the first FOLFIRINOX cycle,there was a significant difference in age and body surface area between the sexes (58.8 [men] and 64.9 years [women], p =0.005 and 1.7 [men]and 1.6 m2[women], p < 0.001, respectively). The median progression-free survival (PFS) and overall survival (OS) were 10.8 and 18.0 months, respectively. There was a trend of longerPFS (10.3 [men] and 11.9 months [women], p = 0.153) and a significantly longer OS(17.9[men] and 25.9 months [women], p=0.019)in female patients. During the first year of FOLFIRINOX treatment, there was a significant difference of the age-corrected dose reduction pattern by sex (a mean of 94.3% dose at the initial cycle and -0.34% of dose reduction per week in menversus a mean of 89.3% dose at the initial cycle and -0.51% of dose reduction per week in women, p-value of the slope:<0.001). There was no difference in the adverse event rates between the sexes.
Conclusion: Female patients showed longer OS despite a more rapid dose reduction during each cycle. Sex differences should be considered during FOLFIRINOX treatment.
Keywords
Pancreatic cancer, FOLFIRINOX, Chemotherapy, Sex
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Jaihwan Kim
Seoul National University Bundang Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0693-1415
Badges
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This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
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History
CURRENT STATUS: Posted
Version 1
Posted 09 Jun, 2020
Community comments: 1
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cancer Biology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background:The combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is a very effectivechemotherapeutic regimen forunresectable pancreatic cancer.Previous studies have reported that female sex may be a predictor of a better response to FOLFIRINOX. This study was aimed at investigating the clinical outcomes and dose modification patterns of FOLFIRINOX by sex.
Methods:Patients with metastatic pancreatic cancer(MPC) who began FOLFIRINOX as the first-line therapy at Seoul National University Bundang Hospital between 2013 and 2018 were enrolled. The patients received at least four chemotherapy cycles. Local regression and a linear mixed model were used to analyze dose modification patterns by sex.
Results:Ninety-seven patients with MPC (54 men;43 women) were enrolled. In the first FOLFIRINOX cycle,there was a significant difference in age and body surface area between the sexes (58.8 [men] and 64.9 years [women], p =0.005 and 1.7 [men]and 1.6 m2[women], p < 0.001, respectively). The median progression-free survival (PFS) and overall survival (OS) were 10.8 and 18.0 months, respectively. There was a trend of longerPFS (10.3 [men] and 11.9 months [women], p = 0.153) and a significantly longer OS(17.9[men] and 25.9 months [women], p=0.019)in female patients. During the first year of FOLFIRINOX treatment, there was a significant difference of the age-corrected dose reduction pattern by sex (a mean of 94.3% dose at the initial cycle and -0.34% of dose reduction per week in menversus a mean of 89.3% dose at the initial cycle and -0.51% of dose reduction per week in women, p-value of the slope:<0.001). There was no difference in the adverse event rates between the sexes.
Conclusion: Female patients showed longer OS despite a more rapid dose reduction during each cycle. Sex differences should be considered during FOLFIRINOX treatment.
Figure 1
Figure 2
Figure 3
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